Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance

Int J Surg. 2016 Jun;30:116-20. doi: 10.1016/j.ijsu.2016.04.041. Epub 2016 Apr 29.


Introduction: Seroma formation in breast cancer patients who have undergone axillary lymph node dissection (ALND) is a source of significant discomfort and morbidity. We aimed to ascertain seroma incidence after ALND, when Harmonic Focus (HF) scalpel is used for dissection instead of conventional diathermy (CD).

Methods(and patients): This retrospective study was carried out in a single hospital over 6 years. Patients were allocated into HF group (HFG) or CD group (CDG). Seroma volume, hospital stay, and complications were evaluated.

Results: Of 94 patients, 42 were in the HFG and 52 in the CDG. Two day median seroma volume was 205 ml (IQR 95-265) for HF, and 227.5 ml (IQR 149-385) for CD. The total median seroma output was 270 ml (IQR 160-478) for HF, and 385 ml (IQR 220-558) for CD. No statistically significant differences between HFG and CDG were identified in these data, as well as patient demographics, operative time, and complication rates. Duration of surgery >2.5 h increased seroma formation (p < 0.001). Mastectomy and ALND increased seroma formation compared to wide local excision (WLE) and ALND (p < 0.05). Nodal involvement, number of lymph nodes resected, and extra nodal spread did not influence seroma formation.

Discussion(and conclusion): In our hands, HF use was not superior to CD in limiting seroma formation in ALND for breast cancer. Increased seroma formation in surgeries >2.5 h in duration is commensurate with surgeries involving mastectomy and ALND (>2.5 h in our study), which entails greater and sustained tissue and lymphovascular trauma.

Keywords: Breast cancer; Conventional diathermy; Electrocautery; Harmonic focus; Seroma.

MeSH terms

  • Axilla
  • Breast Neoplasms / surgery*
  • Dissection / instrumentation
  • Drainage
  • Electrocoagulation / instrumentation*
  • Female
  • Humans
  • Lymph Node Excision / adverse effects*
  • Lymph Node Excision / instrumentation
  • Mastectomy / adverse effects*
  • Middle Aged
  • Retrospective Studies
  • Seroma / etiology
  • Seroma / prevention & control*
  • Seroma / therapy
  • Ultrasonic Surgical Procedures / instrumentation*